Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement?

Anna Sabate Rotes; Crystal R. Bonnichsen; Chelsea L. Reece; Heidi M. Connolly; Harold M. Burkhart; Joseph A. Dearani; Benjamin W. Eidem

doi:10.1016/j.echo.2014.09.012

Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement?

Anna Sabate Rotes, Crystal R. Bonnichsen, Chelsea L. Reece, Heidi M. Connolly, Harold M. Burkhart, Joseph A. Dearani, Benjamin W. Eidem

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

Background Novel echocardiographic techniques based on myocardial deformation have not been extensively evaluated to assess right ventricular (RV) and left ventricular (LV) response after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot.

Methods Between 2003 and 2012, 133 patients undergoing first-time PVR after tetralogy of Fallot repair underwent echocardiographic assessment at Mayo Clinic. The last echocardiogram before PVR and 1 year after surgery were retrospectively analyzed with Velocity Vector Imaging.

Results Mean age at PVR was 35.5 ± 16.2 years (54% women). Longitudinal peak systolic strain and strain rate before PVR were low: for the left ventricle, -14.8 ± 3.5% and -0.8 ± 0.2 sec^-1, and for the right ventricle, -16.2 ± 4.1% and -0.9 ± 0.3 sec^-1, respectively. There was no significant change in either parameter after surgery. A close correlation between LV and RV deformational parameters was found before PVR and was maintained after surgery. In the multivariate analysis, patients with better LV and RV peak systolic strain preoperatively were found to have better LV and RV peak systolic strain after surgery (P =.004 and P =.006, respectively). However, patients with the most improvement in deformation were those with worse RV function preoperatively (P =.002). Mean New York Heart Association class at early follow-up improved from 2.2 ± 0.8 to 1.2 ± 0.6 (P <.0001); RV peak systolic strain was the only factor associated with symptomatic improvement.

Conclusion LV and RV systolic and diastolic deformational parameters were decreased in patients with repaired tetralogy of Fallot undergoing PVR, and there was no significant change after surgery. However, preoperative systolic deformational parameters were predictive of postoperative ventricular function and New York Heart Association class after PVR and may be helpful to identify optimal timing for surgical intervention in this cohort.

Original language	English (US)
Pages (from-to)	1305-1310
Number of pages	6
Journal	Journal of the American Society of Echocardiography
Volume	27
Issue number	12
DOIs	https://doi.org/10.1016/j.echo.2014.09.012
State	Published - Dec 1 2014

Keywords

Fallot
Magnetic resonance imaging
Pulmonary valve replacement
Strain echocardiography
Tetralogy of

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.echo.2014.09.012

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Sabate Rotes, A., Bonnichsen, C. R., Reece, C. L., Connolly, H. M., Burkhart, H. M., Dearani, J. A., & Eidem, B. W. (2014). Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement? Journal of the American Society of Echocardiography, 27(12), 1305-1310. https://doi.org/10.1016/j.echo.2014.09.012

Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement? / Sabate Rotes, Anna; Bonnichsen, Crystal R.; Reece, Chelsea L. et al.
In: Journal of the American Society of Echocardiography, Vol. 27, No. 12, 01.12.2014, p. 1305-1310.

Research output: Contribution to journal › Article › peer-review

Sabate Rotes, A, Bonnichsen, CR, Reece, CL, Connolly, HM, Burkhart, HM, Dearani, JA & Eidem, BW 2014, 'Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement?', Journal of the American Society of Echocardiography, vol. 27, no. 12, pp. 1305-1310. https://doi.org/10.1016/j.echo.2014.09.012

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title = "Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement?",

abstract = "Background Novel echocardiographic techniques based on myocardial deformation have not been extensively evaluated to assess right ventricular (RV) and left ventricular (LV) response after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot.Methods Between 2003 and 2012, 133 patients undergoing first-time PVR after tetralogy of Fallot repair underwent echocardiographic assessment at Mayo Clinic. The last echocardiogram before PVR and 1 year after surgery were retrospectively analyzed with Velocity Vector Imaging.Results Mean age at PVR was 35.5 ± 16.2 years (54% women). Longitudinal peak systolic strain and strain rate before PVR were low: for the left ventricle, -14.8 ± 3.5% and -0.8 ± 0.2 sec-1, and for the right ventricle, -16.2 ± 4.1% and -0.9 ± 0.3 sec-1, respectively. There was no significant change in either parameter after surgery. A close correlation between LV and RV deformational parameters was found before PVR and was maintained after surgery. In the multivariate analysis, patients with better LV and RV peak systolic strain preoperatively were found to have better LV and RV peak systolic strain after surgery (P =.004 and P =.006, respectively). However, patients with the most improvement in deformation were those with worse RV function preoperatively (P =.002). Mean New York Heart Association class at early follow-up improved from 2.2 ± 0.8 to 1.2 ± 0.6 (P <.0001); RV peak systolic strain was the only factor associated with symptomatic improvement.Conclusion LV and RV systolic and diastolic deformational parameters were decreased in patients with repaired tetralogy of Fallot undergoing PVR, and there was no significant change after surgery. However, preoperative systolic deformational parameters were predictive of postoperative ventricular function and New York Heart Association class after PVR and may be helpful to identify optimal timing for surgical intervention in this cohort.",

keywords = "Fallot, Magnetic resonance imaging, Pulmonary valve replacement, Strain echocardiography, Tetralogy of",

author = "{Sabate Rotes}, Anna and Bonnichsen, {Crystal R.} and Reece, {Chelsea L.} and Connolly, {Heidi M.} and Burkhart, {Harold M.} and Dearani, {Joseph A.} and Eidem, {Benjamin W.}",

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AU - Reece, Chelsea L.

AU - Connolly, Heidi M.

AU - Burkhart, Harold M.

AU - Dearani, Joseph A.

AU - Eidem, Benjamin W.

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N2 - Background Novel echocardiographic techniques based on myocardial deformation have not been extensively evaluated to assess right ventricular (RV) and left ventricular (LV) response after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot.Methods Between 2003 and 2012, 133 patients undergoing first-time PVR after tetralogy of Fallot repair underwent echocardiographic assessment at Mayo Clinic. The last echocardiogram before PVR and 1 year after surgery were retrospectively analyzed with Velocity Vector Imaging.Results Mean age at PVR was 35.5 ± 16.2 years (54% women). Longitudinal peak systolic strain and strain rate before PVR were low: for the left ventricle, -14.8 ± 3.5% and -0.8 ± 0.2 sec-1, and for the right ventricle, -16.2 ± 4.1% and -0.9 ± 0.3 sec-1, respectively. There was no significant change in either parameter after surgery. A close correlation between LV and RV deformational parameters was found before PVR and was maintained after surgery. In the multivariate analysis, patients with better LV and RV peak systolic strain preoperatively were found to have better LV and RV peak systolic strain after surgery (P =.004 and P =.006, respectively). However, patients with the most improvement in deformation were those with worse RV function preoperatively (P =.002). Mean New York Heart Association class at early follow-up improved from 2.2 ± 0.8 to 1.2 ± 0.6 (P <.0001); RV peak systolic strain was the only factor associated with symptomatic improvement.Conclusion LV and RV systolic and diastolic deformational parameters were decreased in patients with repaired tetralogy of Fallot undergoing PVR, and there was no significant change after surgery. However, preoperative systolic deformational parameters were predictive of postoperative ventricular function and New York Heart Association class after PVR and may be helpful to identify optimal timing for surgical intervention in this cohort.

AB - Background Novel echocardiographic techniques based on myocardial deformation have not been extensively evaluated to assess right ventricular (RV) and left ventricular (LV) response after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot.Methods Between 2003 and 2012, 133 patients undergoing first-time PVR after tetralogy of Fallot repair underwent echocardiographic assessment at Mayo Clinic. The last echocardiogram before PVR and 1 year after surgery were retrospectively analyzed with Velocity Vector Imaging.Results Mean age at PVR was 35.5 ± 16.2 years (54% women). Longitudinal peak systolic strain and strain rate before PVR were low: for the left ventricle, -14.8 ± 3.5% and -0.8 ± 0.2 sec-1, and for the right ventricle, -16.2 ± 4.1% and -0.9 ± 0.3 sec-1, respectively. There was no significant change in either parameter after surgery. A close correlation between LV and RV deformational parameters was found before PVR and was maintained after surgery. In the multivariate analysis, patients with better LV and RV peak systolic strain preoperatively were found to have better LV and RV peak systolic strain after surgery (P =.004 and P =.006, respectively). However, patients with the most improvement in deformation were those with worse RV function preoperatively (P =.002). Mean New York Heart Association class at early follow-up improved from 2.2 ± 0.8 to 1.2 ± 0.6 (P <.0001); RV peak systolic strain was the only factor associated with symptomatic improvement.Conclusion LV and RV systolic and diastolic deformational parameters were decreased in patients with repaired tetralogy of Fallot undergoing PVR, and there was no significant change after surgery. However, preoperative systolic deformational parameters were predictive of postoperative ventricular function and New York Heart Association class after PVR and may be helpful to identify optimal timing for surgical intervention in this cohort.

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KW - Pulmonary valve replacement

KW - Strain echocardiography

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Long-term follow-up in repaired tetralogy of Fallot: Can deformation imaging help identify optimal timing of pulmonary valve replacement?

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